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Universalizing access to quality primary healthcare
BY SAVERA
SHRADHA RAWAT
DEEPAK PARIHAR
HIMANSHU JOSHI
SAALIM ZAIDI
AYUSH AGARWAL
While India can competitively deliver world-class
health care (witness the success of medical tourism)
the country is seriously underperforming when it
comes to taking care of its own.
CURRENT HEALTH STATUS OF INDIA
Total expenditure on health is 4.2%
of GDP. Of this, current public
expenditure is only 1.1% of GDP.
A serious problem is the improper allocation of
public health care budget i.e. large and increasing
proportion of expenditure on salaries (60 % to90%)
and a markedly reduced (29% to 5%) proportion on
non-salary components like medicines, equipment,
fuel, etc. which has led to a waste of resources
because the health personnel in place cannot work
effectively without other supportive expenditure
The WHO in its Alma Ata Declaration had recommended
that public health care expenditures should be at least 5 per
cent of GDP if equity and universal coverage are to be
realized. Most socialist countries spend 3.5 percent
FINANCIAL ASPECTS OF CURRENT PROBLEM
INDIA is the leading producer of
Generic Drugs but it’s supply has
fallen from 31% in 1987 to 9% in
2004
Use of Generic
Drugs in SPAIN
help them save
2.4 billion per
annum
India is losing more than 6% of its GDP
annually due to premature deaths and
preventable illnesses,
Diseases Estimated deaths in
South East Asia (2008
WHO data)
Est. deaths in India*
(2008)
Tuberculosis 405974 357257
Malaria 43200 38016
Diarrhea 1141586 1004596
Dengue 7064 6216
Nutritional deficiencies 84,123 74028
Maternal conditions 80620 70946
Total 1762567 1551059
*Assuming 88% of these deaths were
in India, since it accounts for 88% of
the population in this region.
However, official records show the
numbers to be far lesser. For
example, India had only around 1000
reported malaria deaths in 2008.
However, when the entire SE Asian
region is taken the number of
estimated malaria deaths is 43,200.
Now this region has a total
population of 1.3 billion and India
had an estimated population of 1.15
billion in 2008. So it’s clearly
implausible that despite having 88%
of the population it only accounted
for 2 percent of malaria deaths. So
we’re assuming that 88% of all
deaths caused by these diseases are
in India.
It’s extremely sad that so many
Indians are losing their lives to
diseases and conditions that could’ve
been easily avoided with the most
basic of healthcare services
NEED FOR DOCTOR OF BASIC DISEASES???
Acc. to WHO South East Asian Countries are Bangladesh, Bhutan,
Democratic People’s Republic of Korea, India, Indonesia, Maldives,
Myanmar, Nepal, Sri-Lanka, Thailand & Timor-Leste
 MBBS - Bachelors of medicine and bachelor
Of Surgery.
o The curriculum includes preclinical, para-
clinical, clinical subjects comprising of social
& preventive medicine, general medicine
and general surgery.
 5 year course
 Total expenditure=12.5 lakh( in private
institutions).
o After graduation, many students opt for
higher studies in US or other countries.
 BPHC - Bachelor Of Primary Health Care.
 The Curriculum will only be limited to Diagnosis,
treatment & Prevention of common diseases.
 Curriculum should also include disaster
management courses & logistics
 3 years course
 Total expenditure will be much less.
 BPHC will be full time government employee
 BPHC graduates will work for a period of 5 yrs in
their native villages.
MBBS BPHC
WHAT WE NEED???
In the last two years AICTE received 500 applications
from colleges seeking permission to shut down most
of these colleges are in rural areas or Tier III cities
,utilizing these colleges to train BPHC students will be
very cost effective as major infrastructure like
classrooms are already present.
We propose a 50-30-20 sharing of fees between
central govt, state govt and student, where central
& state government will bear 50%-30% of tuition
fees respectively and student will pay 20 % and will
sign an agreement to work in villages for minimum
05 years
The performance of BPHC doctors will be analyzed annually by their
Medical Officer preferably MD (Community Health Care).
BPHC
Gram Panchayat will also analyze
the performance of BPHC
independently.
THE PLAN
SELECTION PROCEDURE
A national entrance exam to be
conducted by Medical Council of
India.
Eligibility: Students who
completed their intermediate
with Biology as a subject
• Increase in the existing expenditure on public
health care to 3% of GDP.
Major hospitals and pharmaceutical companies
should set up medical cells in villages where BPHC
will work.
At least 0.5% of the 2%(as set by the companies act
2013) to be spent on Health Care.
Why only Tata Memorial Hospital when we have 72
companies with billion dollar net worth?
• The BPHC doctors will wear logos of any company
for 2 years which finances 25% of their education
expenses
STAKEHOLDER
HEALTH CARE PROVIDERS
GOVERNMENT
CORPORATE
SPONSORS
57.80
%
87.60
%
86%
78.80
%
13.80
%
Out of Pocket Expenditure
Brazil
Russia
India
China
South Africa
PROGRAMME
SPONSOR
They will be the regional
sponsors
Will provide air
ambulances, ambulances
and medical supplies.
COMMUNICATION
SPONSOR
They will sponsor
communication
equipments like cell
phones and Aakash
tablets
For effective functioning
it will be vital that
BPHC have access to
communication facilities
HELPING HANDS
TRAINING COST
For a 3 year course of PHC with study focused solely on basic
diseases estimated cost will be around 3lakh for entire
course.
• Central Govt will pay only 50% i.e. 1.50 lakhs
Total expenditure= 1.5 lakhs *593731 inhabited villages of
India= Rs 9000 crore(approx)
• State Govt will pay 30% i.e. 90,000
Total expenditure=90,000*of the 593731 villages = 5500
crore
91552 villages have population less than 200
So total expenditure will be much less
5% spending of profit on health
care means 53,000crores
Tax collection from corporations
also increases every year
sometimes as high as around
20%
ESTIMATED COST OF IMPLEMENTATION
India has enough for everyone’s NEED but not enough for anyone’s
GREED.
-Mahatma Gandhi
ORGANISATION COST
•Pay band 9300-34800 with 3% annual increment
•Grade pay:4200
•Total expenditure = 3 lakhs * 593731 villages = Rs 10,000
crore
3%of India's 2012 GDP is
36,91,68,30,00,000 i.e. 3lakh
crores
Even in the worst economic
conditions G.D.P. grows by 4%
each year Apart from the training and salary of BPHC no additional
investment would be required. We propose utilization of
NRHM resources for equipments and other services.
Principal Secretary(H & FW)
Mission Director-NRHM
Commissioner Rank Officer
Directorate Of Family
Welfare
Directorate Of Medical &
Health
State Programme Management
Unit(SPMU)
District PMU
Block PMU headed by
Medical Officer In-charge
ASHA
ORGANIZATIONAL SETUP
BPHC
BPHC & ASHA will co-ordinate each other
 Central government should devise policy for providing better housing and education facility for children of
Doctors to make rural posting more attractive
 To avoid bankrupting the country with healthcare costs we must
emphasize prevention, specifically teaching prevention.
 There is a large no of engineering and management colleges which fail to attract students, encourage them
to start nursing, pathology and other medical support courses by giving tax breaks and other incentives.
 Large chunk of health care budget is spent on building infrastructure that ultimately goes to waste due to
lack of maintenance. Private health care has a major presence in India, a PPP model can be implemented
where private providers must provide health care to poor, for which the government will pay by utilizing
Aadhar Cards .
 Practitioners of Indigenous System of Medicines could extensively compensate for deficits in primary health
care services.
Only 193 out of total 640 districts
have a medical college.
There are approximately 0.81
nurses per allopathic physician in
India, this is not cost effective at
all.
India's ratio of nine hospital beds
per 10,000 people is far from
adequate
SUPPORTING MEASURES
GRIEVANCE REDRESSAL MECHANISM
 Complaints and suggestions can be directed to Gram Pradhans,
Medical Officers, DM's, against all the BPHCs who ask for bribe or
display negligence.
 Suggestion Boxes for BPHC to be placed in all CHC&PHC
 24 hours help line to report absentee doctors or any negligance.
 Only training the BPHC will not be enough, we have to ensure the
people graduating from the course are competent enough to take
care of their duties.
 This idea requires a substantial spending on health care, it may be
tough in the current economic scenario.
LIMITATIONS
• 286,119,689 Indians are
living in villages
• 50% of all villagers have no
access to healthcare providers
(Indiafacts.in and India Development gateway)
• 1551059 lives in 2008 could
have been saved
IMPACT
IMAGINE WHAT WE CAN
ACHIEVE NOW!!!
During the recent calamity in
Uttarakhand most of the affected
victims were senior citizens
already suffering from chronic
conditions like Hypertension
Arthritis, Bronchal Asthama,
Diabetes .There was an
immediate need of primary
health care for them and people
with minor injuries
 India knowledge @wharton
 WHO country cooperative strategy
 http://censusindia.gov.in
 http://databank.worldbank.org
 “Do the Poor Benefit from Public Spending on Healthcare in India?” A research paper by
Consortium for Research on Equitable Health Systems (CREHS).The authors are based at Indian
Institute of Technology (Madras), India.
 “Strengthening of primary health care” A research paper by Mr.Rajiv Yeravdekar, Director
Symbiosis Institute of Health Sciences
 “HEALTH FINANCING IN INDIA” A research paper by R.D. Bansal Ex-Deputy Director General
(Medical Education, Hospitals and Planning) D.G.H.S., Ministry of Health and Family Welfare,
New Delhi.
 Reuters India
 NRHM information portal
REFERENCES

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Team savera

  • 1. Universalizing access to quality primary healthcare BY SAVERA SHRADHA RAWAT DEEPAK PARIHAR HIMANSHU JOSHI SAALIM ZAIDI AYUSH AGARWAL
  • 2. While India can competitively deliver world-class health care (witness the success of medical tourism) the country is seriously underperforming when it comes to taking care of its own. CURRENT HEALTH STATUS OF INDIA
  • 3. Total expenditure on health is 4.2% of GDP. Of this, current public expenditure is only 1.1% of GDP. A serious problem is the improper allocation of public health care budget i.e. large and increasing proportion of expenditure on salaries (60 % to90%) and a markedly reduced (29% to 5%) proportion on non-salary components like medicines, equipment, fuel, etc. which has led to a waste of resources because the health personnel in place cannot work effectively without other supportive expenditure The WHO in its Alma Ata Declaration had recommended that public health care expenditures should be at least 5 per cent of GDP if equity and universal coverage are to be realized. Most socialist countries spend 3.5 percent FINANCIAL ASPECTS OF CURRENT PROBLEM INDIA is the leading producer of Generic Drugs but it’s supply has fallen from 31% in 1987 to 9% in 2004 Use of Generic Drugs in SPAIN help them save 2.4 billion per annum India is losing more than 6% of its GDP annually due to premature deaths and preventable illnesses,
  • 4. Diseases Estimated deaths in South East Asia (2008 WHO data) Est. deaths in India* (2008) Tuberculosis 405974 357257 Malaria 43200 38016 Diarrhea 1141586 1004596 Dengue 7064 6216 Nutritional deficiencies 84,123 74028 Maternal conditions 80620 70946 Total 1762567 1551059 *Assuming 88% of these deaths were in India, since it accounts for 88% of the population in this region. However, official records show the numbers to be far lesser. For example, India had only around 1000 reported malaria deaths in 2008. However, when the entire SE Asian region is taken the number of estimated malaria deaths is 43,200. Now this region has a total population of 1.3 billion and India had an estimated population of 1.15 billion in 2008. So it’s clearly implausible that despite having 88% of the population it only accounted for 2 percent of malaria deaths. So we’re assuming that 88% of all deaths caused by these diseases are in India. It’s extremely sad that so many Indians are losing their lives to diseases and conditions that could’ve been easily avoided with the most basic of healthcare services NEED FOR DOCTOR OF BASIC DISEASES??? Acc. to WHO South East Asian Countries are Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri-Lanka, Thailand & Timor-Leste
  • 5.  MBBS - Bachelors of medicine and bachelor Of Surgery. o The curriculum includes preclinical, para- clinical, clinical subjects comprising of social & preventive medicine, general medicine and general surgery.  5 year course  Total expenditure=12.5 lakh( in private institutions). o After graduation, many students opt for higher studies in US or other countries.  BPHC - Bachelor Of Primary Health Care.  The Curriculum will only be limited to Diagnosis, treatment & Prevention of common diseases.  Curriculum should also include disaster management courses & logistics  3 years course  Total expenditure will be much less.  BPHC will be full time government employee  BPHC graduates will work for a period of 5 yrs in their native villages. MBBS BPHC WHAT WE NEED???
  • 6. In the last two years AICTE received 500 applications from colleges seeking permission to shut down most of these colleges are in rural areas or Tier III cities ,utilizing these colleges to train BPHC students will be very cost effective as major infrastructure like classrooms are already present. We propose a 50-30-20 sharing of fees between central govt, state govt and student, where central & state government will bear 50%-30% of tuition fees respectively and student will pay 20 % and will sign an agreement to work in villages for minimum 05 years The performance of BPHC doctors will be analyzed annually by their Medical Officer preferably MD (Community Health Care). BPHC Gram Panchayat will also analyze the performance of BPHC independently. THE PLAN SELECTION PROCEDURE A national entrance exam to be conducted by Medical Council of India. Eligibility: Students who completed their intermediate with Biology as a subject
  • 7. • Increase in the existing expenditure on public health care to 3% of GDP. Major hospitals and pharmaceutical companies should set up medical cells in villages where BPHC will work. At least 0.5% of the 2%(as set by the companies act 2013) to be spent on Health Care. Why only Tata Memorial Hospital when we have 72 companies with billion dollar net worth? • The BPHC doctors will wear logos of any company for 2 years which finances 25% of their education expenses STAKEHOLDER HEALTH CARE PROVIDERS GOVERNMENT CORPORATE SPONSORS 57.80 % 87.60 % 86% 78.80 % 13.80 % Out of Pocket Expenditure Brazil Russia India China South Africa
  • 8. PROGRAMME SPONSOR They will be the regional sponsors Will provide air ambulances, ambulances and medical supplies. COMMUNICATION SPONSOR They will sponsor communication equipments like cell phones and Aakash tablets For effective functioning it will be vital that BPHC have access to communication facilities HELPING HANDS
  • 9. TRAINING COST For a 3 year course of PHC with study focused solely on basic diseases estimated cost will be around 3lakh for entire course. • Central Govt will pay only 50% i.e. 1.50 lakhs Total expenditure= 1.5 lakhs *593731 inhabited villages of India= Rs 9000 crore(approx) • State Govt will pay 30% i.e. 90,000 Total expenditure=90,000*of the 593731 villages = 5500 crore 91552 villages have population less than 200 So total expenditure will be much less 5% spending of profit on health care means 53,000crores Tax collection from corporations also increases every year sometimes as high as around 20% ESTIMATED COST OF IMPLEMENTATION India has enough for everyone’s NEED but not enough for anyone’s GREED. -Mahatma Gandhi ORGANISATION COST •Pay band 9300-34800 with 3% annual increment •Grade pay:4200 •Total expenditure = 3 lakhs * 593731 villages = Rs 10,000 crore 3%of India's 2012 GDP is 36,91,68,30,00,000 i.e. 3lakh crores Even in the worst economic conditions G.D.P. grows by 4% each year Apart from the training and salary of BPHC no additional investment would be required. We propose utilization of NRHM resources for equipments and other services.
  • 10. Principal Secretary(H & FW) Mission Director-NRHM Commissioner Rank Officer Directorate Of Family Welfare Directorate Of Medical & Health State Programme Management Unit(SPMU) District PMU Block PMU headed by Medical Officer In-charge ASHA ORGANIZATIONAL SETUP BPHC BPHC & ASHA will co-ordinate each other
  • 11.  Central government should devise policy for providing better housing and education facility for children of Doctors to make rural posting more attractive  To avoid bankrupting the country with healthcare costs we must emphasize prevention, specifically teaching prevention.  There is a large no of engineering and management colleges which fail to attract students, encourage them to start nursing, pathology and other medical support courses by giving tax breaks and other incentives.  Large chunk of health care budget is spent on building infrastructure that ultimately goes to waste due to lack of maintenance. Private health care has a major presence in India, a PPP model can be implemented where private providers must provide health care to poor, for which the government will pay by utilizing Aadhar Cards .  Practitioners of Indigenous System of Medicines could extensively compensate for deficits in primary health care services. Only 193 out of total 640 districts have a medical college. There are approximately 0.81 nurses per allopathic physician in India, this is not cost effective at all. India's ratio of nine hospital beds per 10,000 people is far from adequate SUPPORTING MEASURES
  • 12. GRIEVANCE REDRESSAL MECHANISM  Complaints and suggestions can be directed to Gram Pradhans, Medical Officers, DM's, against all the BPHCs who ask for bribe or display negligence.  Suggestion Boxes for BPHC to be placed in all CHC&PHC  24 hours help line to report absentee doctors or any negligance.  Only training the BPHC will not be enough, we have to ensure the people graduating from the course are competent enough to take care of their duties.  This idea requires a substantial spending on health care, it may be tough in the current economic scenario. LIMITATIONS
  • 13. • 286,119,689 Indians are living in villages • 50% of all villagers have no access to healthcare providers (Indiafacts.in and India Development gateway) • 1551059 lives in 2008 could have been saved IMPACT IMAGINE WHAT WE CAN ACHIEVE NOW!!! During the recent calamity in Uttarakhand most of the affected victims were senior citizens already suffering from chronic conditions like Hypertension Arthritis, Bronchal Asthama, Diabetes .There was an immediate need of primary health care for them and people with minor injuries
  • 14.  India knowledge @wharton  WHO country cooperative strategy  http://censusindia.gov.in  http://databank.worldbank.org  “Do the Poor Benefit from Public Spending on Healthcare in India?” A research paper by Consortium for Research on Equitable Health Systems (CREHS).The authors are based at Indian Institute of Technology (Madras), India.  “Strengthening of primary health care” A research paper by Mr.Rajiv Yeravdekar, Director Symbiosis Institute of Health Sciences  “HEALTH FINANCING IN INDIA” A research paper by R.D. Bansal Ex-Deputy Director General (Medical Education, Hospitals and Planning) D.G.H.S., Ministry of Health and Family Welfare, New Delhi.  Reuters India  NRHM information portal REFERENCES